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    <h1>The National Institute of Health Stroke Scale (NIHSS) For Acute Stoke</h1>
    <table border="1" style="border-color: black">
        <tr><td width="450"  align="center"> Date of examination</td><td ></td></tr>
        <tr>
            <td valign="top"> 1a. Level of consciousness </td>
            <td style="padding-left: 5px">
                <select name="no1a">
                    <option value="0">Alert (0)</option>
                    <option value="1">Drowsy (1)</option>
                    <option value="2">Stuporous (2)</option>
                    <option value="3">Coma (3)</option>
                </select>
            </td>
        </tr>
        <tr>
            <td valign="top"> 1b. Two questions ถามอายุและเดือน </td>
            <td style="padding-left: 5px">
                <select name="no1b">
                    <option value="0">Both correct (0)</option>
                    <option value="1">One correct (1)</option>
                    <option value="2">None correct (2)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 1c. Two commands หลับตา ลืมตาและกำมือ แบมือ  </td>
            <td style="padding-left: 5px">
                <select name="no1c">
                    <option value="0">Obeys both (0)</option>
                    <option value="1">Obeys none (1)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 2. Best gaze มองด้านข้าง  </td>
            <td style="padding-left: 5px">
                <select name="no2">
                    <option value="0">Normal (0)</option>
                    <option value="1">Partial gaze palsy (1)</option>
                    <option value="2">Forced deviation (2)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 3. Best visual (visual field)</td>
            <td style="padding-left: 5px">
                <select name="no3">
                    <option value="0">No visual loss (0)</option>
                    <option value="1">Partial hemianopia (1)</option>
                    <option value="2">Complete  hemianopia (2)</option>
                    <option value="3">Bilateral hemianopia (3)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 4. Facial palsy</td>
            <td style="padding-left: 5px">
                <select name="no4">
                    <option value="0">Normal (0)</option>
                    <option value="1">Minor (1)</option>
                    <option value="2">Partial (2)</option>
                    <option value="3">Complete (3)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 5a. Best Motor Lt arms นั่งยกแขน 90 องศา 10 วินาทีหรือนอนยกแขน 45 องศา</td>
            <td style="padding-left: 5px">
                <select name="no5a">
                    <option value="0">No drift (0)</option>
                    <option value="1">Drift (1)</option>
                    <option value="2">Fall in 10 secs (2)</option>
                    <option value="3">No effort against gravity (3)</option>
                    <option value="4">No movement (4)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 5b. Best Motor Rt arms นั่งยกแขน 90 องศา 10 วินาทีหรือนอนยกแขน 45 องศา</td>
            <td style="padding-left: 5px">
                <select name="no5b">
                    <option value="0">No drift (0)</option>
                    <option value="1">Drift (1)</option>
                    <option value="2">Fall in 10 secs (2)</option>
                    <option value="3">No effort against gravity (3)</option>
                    <option value="4">No movement (4)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 6a. Best Motor Lt legs นอนยกขา 30 องศา 5 วินาที </td>
            <td style="padding-left: 5px">
                <select name="no6a">
                    <option value="0">No drift (0)</option>
                    <option value="1">Drift (1)</option>
                    <option value="2">Fall in 10 secs (2)</option>
                    <option value="3">No effort against gravity (3)</option>
                    <option value="4">No movement (4)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 6b. Best Motor Rt legs นอนยกขา 30 องศา 5 วินาที </td>
            <td style="padding-left: 5px">
                <select name="no6b">
                    <option value="0">No drift (0)</option>
                    <option value="1">Drift (1)</option>
                    <option value="2">Fall in 10 secs (2)</option>
                    <option value="3">No effort against gravity (3)</option>
                    <option value="4">No movement (4)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 7. Limb Ataxia </td>
            <td style="padding-left: 5px">
                <select name="no7">
                    <option value="0">Absent (0)</option>
                    <option value="1">Upper or lower limb (1)</option>
                    <option value="2">Upper & lower limb (2)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 8. Sensory </td>
            <td style="padding-left: 5px">
                <select name="no8">
                    <option value="0">Normal (0)</option>
                    <option value="1">Partial loss (1)</option>
                    <option value="2">Dense loss (2)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 9. Best language Aphasia </td>
            <td style="padding-left: 5px">
                <select name="no9">
                    <option value="0">No aphasia (0)</option>
                    <option value="1">Mild to moderate (1)</option>
                    <option value="2">Severe (2)</option>
                    <option value="3">Mute (3)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 10. Dysarthria </td>
            <td style="padding-left: 5px">
                <select name="no10">
                    <option value="0">Normal articulation (0)</option>
                    <option value="1">Mild to moderate (1)</option>
                    <option value="2">Severe (2)</option>
                </select>
                </td>
        </tr>
        <tr>
            <td valign="top"> 11. Neglect </td>
            <td style="padding-left: 5px">
                <select name="no11">
                    <option value="0">No neglect (0)</option>
                    <option value="1">Sensory or visual (1)</option>
                    <option value="2">Sensory & visual (2)</option>
                </select>
                </td>
        </tr>
        <tr><td colspan="3"><form action="" target="_blank"><input type="submit" value="บันทึก"></form> </td></tr>
    </table>

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